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PREAPPLICATION CONSULTATION FORM <br /> REQUEST FOR APPROVAL - SUBDIVISION <br /> BtTPNETT COUNTY LAND USE/ZONING DEPARTMENT <br /> BURNETT COUNTY GOVERNMENT CENTER, SIREN, WI 54872 <br /> A-•PLICANT: jlVe IGN ,E'_ OWNER: <br /> ,Lf <br /> 1�.�E'.6—�E,�. rte//, S4g�3 �✓,ia�7iiy�s /�1.�./, �So..�3 <br /> PHONE: <br /> 8�� - ���'S PHONE: <br /> ORIGLVAL PARCEL OF INFORMATION: <br /> - LOCATION OF PROPERTY �� J AJ 11141 <br /> - SECTION L?' TOWN 4c RANGE 7 tA,/ SIZE <br /> - LEGAL DESCRI <br /> - CURRENT' Z IPIt'_ f FLOODPLAIN YIN' WETLANDS YIN <br /> NEW PARCEL INFORMAT - <br /> - LAND SURVEYOR PREPARING PLAT/MAP <br /> - NUMBER OF LOTS PROPOSED ZONING /e <br /> - REGIONAL FLOOD ELEVATION A / <br /> - WILL ACCESS TO NAVIGABLE BODY OF WATER BE PROVIDED/AVAILABLE YMN✓ <br /> - TYPE OF ACCESS (EZ. OUTLOTo EASEMENT, ETC- ) <br /> - PROPOSED WATER AND SANITARY SYSTEM' <br /> - PROPOSED USE: RESIDENTIAL COMMERCIAL OTRM <br /> DATE SIGNATURE � - <br /> FEES COLLECTED: <br /> DATE OF LAND USE COMMITTEE PRELIMINARY ACCEPTANCE ACTION <br /> DATS' OF LAND IISE COMMITTEE FINAL ACCEPTANCE ACTION <br />